【摘要】 目的通过比较不同血浆同型半胱氨酸(homocysteine,Hcy)浓度的急性ST段抬高型心肌梗死(STsegment elevation acute myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后1个月、6个月、12个月的左心室舒张末期直径(left ventricular end-diastolic diameter,LVDd)和左心室射血分数(left ventricular ejection fraction,LVEF),探讨血浆Hcy浓度对PCI治疗后左心室重构的影响。方法 110例STEMI患者入院第二天清晨空腹(禁食10 h以上)抽取静脉血检测血浆Hcy浓度,并根据血浆Hcy浓度分为Hcy正常组、Hcy轻度升高组(15~30μmol/L)、Hcy中-重度升高组(>30μmol/L)。用超声心动图随访3组患者PCI治疗后1个月、6个月、12个月的LVDd、LVEF并进行比较。结果 PCI治疗后1个月3组左心室重构指标比较,差异无统计学意义(P>0.05)。中-重度升高组PCI治疗后6个月左心室重构指标与Hcy正常组、Hcy轻度升高组比较,差异有统计学意义(P<0.05);Hcy正常组、Hcy轻度升高组之间比较,差异无统计学意义(P>0.05);3组左心室重构指标PCI治疗后12个月两两比较,差异有统计学意义(P<0.05)。结论血浆Hcy浓度可以影响STEMI患者PCI治疗后心室重构,特别是血浆Hcy浓度中-重度升高STEMI患者早期即出现严重的心室重构。更多还原

【Abstract】 Objectives To explore the impact of plasma concentration of homocysteine(Hcy) on left ventricular remodeling by comparing the differences in left ventricular end-diastolic diameter(LVDd) and left ventricular ejection fraction(LVEF)in ST- segment elevation acute myocardial infarction( STEMI) patients with different plasma concentrations of Hcy1 month, 6 months and 12 months after percutaneous coronary intervention(PCI). Methods Plasma concentrations of Hcy in 110 patients with STEMI were detected on the next day morning after admission(fasted for 10 h or more) and they were divided into 3 groups according to the plasma concentrations of Hcy : normal Hcy group, slightly elevated Hcy group(15-30 μmol / L), moderately-to-severely elevated Hcy group(>30 μmol / L). LVDd and LVEF were detected and compared among the three groups by echocardiography 1 month, 6 months and 12 months after PCI.Results Differences in left ventricular remodeling indexes among the three groups 1 month after PCI were not statistically significant(P >0.05). Left ventricular remodeling indexes 6 months after PCI in moderately-to-severely elevated Hcy group had statistically significant differences compared with those in normal Hcy group and slightly elevated Hcy group(P<0.05), but the difference between normal Hcy group and slightly elevated Hcy group was not statistically significant(P>0.05). Differences in left ventricular remodeling indexes 12 months after PCI among the three groups were statistically significant(P <0.05). Conclusions Hcy can affect ventricular remodeling in patients with STEMI after PCI, especially severe ventricular remodeling can occur earlier in patients with moderately-to-severely elevated plasma concentrations of Hcy.更多还原